Recent decrease in non-relapse mortality due to GVHD and infection after allogeneic hematopoietic cell transplantation in non-remission acute leukemia

S. Kurosawa, K. Yakushijin, T. Yamaguchi, Y. Atsuta, T. Nagamura-Inoue, H. Akiyama, S. Taniguchi, K. Miyamura, S. Takahashi, T. Eto, H. Ogawa, M. Kurokawa, J. Tanaka, K. Kawa, K. Kato, R. Suzuki, Y. Morishima, H. Sakamaki, T. Fukuda

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    Abstract

    Although recent improvements have been indicated in the outcome after allogeneic hematopoietic cell transplantation (allo-HCT), little information is available on how changes in transplant modalities have affected the outcomes after allo-HCT in non-remission, based on patient age, donor source and disease type. We compared the incidence and causes of non-relapse mortality (NRM) after allo-HCT in non-remission among three consecutive four-year periods using a nationwide transplant outcome registry database. A total of 3308 patients with acute leukemia in non-remission were analyzed. The risk of NRM decreased over the three periods, and the hazard ratios (HRs) in 2001-2004 and 2005-2008 compared with 1997-2000 were 0.86 (95% CI, 0.70-1.06; P=0.16) and 0.65 (95% CI, 0.53-0.80; P<0.01), respectively. A significant decrease in the HR for overall mortality was also observed in 2005-2008 (HR 0.85; 95% CI, 0.75-0.97; P=0.02). We found that a decrease in the incidences of death due to GVHD and infection contributed to the reduction in NRM, to which high-resolution donor-recipient HLA matching and other improvements may have contributed. As none of the subgroups showed improved survival without a reduction in NRM, the effective prevention of transplant-related complications appears to be necessary for improving outcomes after allo-HCT in non-remission.

    Original languageEnglish
    Pages (from-to)1198-1204
    Number of pages7
    JournalBone Marrow Transplantation
    Volume48
    Issue number9
    DOIs
    Publication statusPublished - Sep 1 2013

    All Science Journal Classification (ASJC) codes

    • Hematology
    • Transplantation

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  • Cite this

    Kurosawa, S., Yakushijin, K., Yamaguchi, T., Atsuta, Y., Nagamura-Inoue, T., Akiyama, H., Taniguchi, S., Miyamura, K., Takahashi, S., Eto, T., Ogawa, H., Kurokawa, M., Tanaka, J., Kawa, K., Kato, K., Suzuki, R., Morishima, Y., Sakamaki, H., & Fukuda, T. (2013). Recent decrease in non-relapse mortality due to GVHD and infection after allogeneic hematopoietic cell transplantation in non-remission acute leukemia. Bone Marrow Transplantation, 48(9), 1198-1204. https://doi.org/10.1038/bmt.2013.42